Provider Demographics
NPI:1538176300
Name:POTTER, JOHN L (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:POTTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD.
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-433-2300
Mailing Address - Fax:610-433-4592
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD.
Practice Address - Street 2:SUITE 2800
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-433-2300
Practice Address - Fax:610-433-4592
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD5028897L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA743038222OtherTAX ID#